Southeast Asia

Philippines sits on HIV time bomb
By Ted Lerner

MANILA - It would probably be a fair assessment to say that a sizable majority of Filipinos in this mainly Catholic nation believe in miracles. But even the most pious of believers might have a difficult time swallowing one particular miracle being peddled these days.

According to the Department of Health (DOH), the number of Filipinos who had, as of 2002, contracted the human immunodeficiency virus (HIV) stood at a mere 1,503. Now compare that to the numbers which, according to figures from the Joint United Nations Program on HIV/AIDS (UNAIDS), showed 7.1 million people in the Asia-Pacific region with HIV at the end of 2001 out of a total 40 million people worldwide. An estimated 1.07 million people in the Asia-Pacific region got infected in 2001 alone, with close to half a million deaths due to AIDS, the disease HIV causes, in the same year.

Yet the Philippines only reported a grand total of 1,503 cases of HIV, which is one of the lowest infection rates in the world. This in a country that has one of the lowest rates of condom usage in Asia. This in a country that has anywhere from half a million to 2 million sex workers, a good majority of whom don't require their customers to wear condoms. This in a nation that has more than 7 million overseas workers, separated from spouses and often engaging in risky sexual behavior. This in a country that, as of the moment, has practically no awareness program to teach the exploding population of young people about the dangers of HIV/AIDS.

Did the HIV/AIDS epidemic pass the Philippines by, as many in government would like to believe? Is this another astonishing miracle in this highly religious country? What does the Philippines know that other countries don't, seeing that it has seemingly avoided the HIV/AIDS epidemic?

These are the questions which form the premise of a frightening new book from Australian author and longtime Philippine resident Earl Wilkinson, AIDS Failure Philippines? (2003, Book of Dreams). Right from the book's ominous cover, it becomes clear the answers to these questions are not what government officials would want to hear.

Chapter by chapter Wilkinson systematically lays bare the bitter truth behind the incredibly low HIV/AIDS figures being dispense by the Philippine government. The 75-years-young author, who has been a crusader for social issues in the Philippines for many years, writes that, "in the investigations, the more questions that were posed, the thicker the blanket of silence came down". But through meticulous research he manages to show that while the government proudly proclaims that the HIV/AIDS epidemic has passed the Philippines by, the scope of the problem is, in fact, much larger than anyone knows. In fact, Wilkinson points out, the Philippines couldn't possibly have such a low HIV/AIDS rate as all the ingredients of an epidemic clearly exist in the country. Instead, he insists, the Philippines is sitting on a social time bomb fueled by utter complacency and denial on the part of the government. And if something isn't done to tackle the problem soon, he says, an entire generation of Filipinos may be unnecessarily decimated.

The operative phrase used by officials here to describe the scope of HIV/AIDS in the country is "low and slow". Some have claimed that this is because AIDS is a foreign affliction, or that because Filipinos are fond of praying. Even President Gloria Macapagal-Arroyo stated before a major AIDS conference in Manila that the reason for the low AIDS rate in the country was that Filipinos have "high morality". The Department of Health doesn't go that far, but it does offer several official reasons HIV/AIDS in the Philippines is "low and slow".

Among them are that female sex workers have fewer sexual partners than their counterparts in other countries; Filipino men do not frequent sex workers as much as men in other countries, because, they say, of moral-ethical pressures and lack of income; anal sex is not common in the Philippines; there are fewer injecting drugs in the Philippines; Filipinos tend to start having sex at a later age than people elsewhere.

Wilkinson points out, however, that while some of the reasons may, if taken at face value, be true, one only has to dig a little deeper to see that the DOH has its head firmly stuck in the sand. Yes, the sex workers may not have as many customers as, say, those in Thailand. But a more revealing fact is that a good percentage of Filipino sex workers do not require their customers to wear condoms. The claim that Filipino men don't frequent sex workers as much as men in other countries because of moral-ethical pressures and lack of income is also easily shot down. In almost any city, town or village in the Philippines, cheap sex can be easily found in beer gardens and nightclubs. On the claim that Filipinos become sexually active at a later age than people elsewhere, one non-governmental organization (NGO) study revealed that among males, the starting age is between 12 and 14, while for women the starting age is between 15 and 18.

Wilkinson spends several chapters discussing condom use, or the lack of it, and the controversies this humble rubber sheath has caused in the Philippines. It is an accepted fact internationally that condoms work in helping to stop the spread of sexually transmitted diseases (STIs) including AIDS. The Catholic Church, however, sees the condom as a contraceptive device and thus bans its flock from using them. In the Philippines the Catholic Church has always held great power and their influence has led to disastrous results for awareness campaigns.

In the early 1990s the government of president Fidel Ramos, a Protestant by religion, made some strides in family planning and AIDS awareness. Ramos knew that to advance economically, the Philippines had to slow down its population growth, which at 2.3 percent annually is one of the highest in Asia. At the time HIV/AIDS was also becoming a looming problem. Ramos' health secretary, Dr Juan Flavier, realized that the Church strictly disapproved of the promotion of any contraceptives, especially condoms, and promoting them could result in a backlash. But with AIDS becoming an obvious threat, Flavier saw an opening. He started a nationwide, high-profile campaign promoting the use of condoms as a way to slow population growth and to help stop the spread of HIV/AIDS.

The public at large seemed to like the campaign and responded favorably. The Catholic Church was incensed, however. Promoting condoms, as well as sex education, they said, promotes promiscuity. They lambasted Flavier in the press and from the pulpit.

Wilkinson documents how, despite international scientific acceptance of the fact that the use of condoms is the best deterrent against contracting HIV - save for abstinence - the Catholic Church in the Philippines embarked on a massive and aggressive disinformation campaign designed to condemn condoms, making outrageous claims that they are in fact dangerous. Through the church pulpit, led by the Archbishop of Manila, Jaime Cardinal Sin, letters sent to the editor of major newspapers and pro-church NGOs, the Church proclaimed that the microscopic pores in the latex of condoms were not small enough to prevent the AIDS virus from passing through. One group, Pro-Life Philippines, actually altered a Johns Hopkins University report on condoms - which stated that condoms do indeed work - then distributed the information in its own pamphlets, saying the report states that condoms leak the virus.

The Church and its backers took their argument even further, saying publicly that promoting contraceptive devices actually helps spread HIV. One priest's writing in a local paper actually made the claim that the DOH was in effect responsible for the rising number of AIDS cases in the Philippines. This despite the fact that the figures make clear that the use of condoms decreases the spread of sexually transmitted diseases. In Thailand the "100 Percent Condom" program has been one of the world's most successful. Condom usage for sex workers went from 25 percent of all sex acts to 90 percent. Naturally STI rates in Thailand declined by 80 percent.

Unfortunately the campaign against condoms in the Philippines has worked, with condom usage falling dramatically in recent years. One recent study said that only 1.7 percent of sexually active men use condoms. In the southern seaport city of Davao, condom use by sex workers went from 36 percent six years ago to only 9 percent in 2002. Of 300 sex workers polled there, 273 said they have unprotected sex with customers at least two times a week. Concurrently STIs have been rising dramatically in Davao, so it must stand to reason that so too has HIV. Amazingly, though, between 1998 and 2002 not one case of HIV has been reported in Davao.

Under President Arroyo, a staunch Catholic who toes the Church line on nearly every issue, STI and HIV/AIDS awareness campaigns have practically disappeared. The very department of the government tasked to do all it can to contain an HIV/AIDS epidemic is refusing to promote the use of condoms. Provisions for contraceptive supply procurement were incorporated into the Department of Health budget for 2002. However, fundamentalist Catholic groups, who have played a big part in Arroyo's government, succeeded in derailing the purchase. Apparently the DOH had to get the agreement of the Church for the purchase and, thus, the US$12 million acquisition was aborted. The 2001 budget of $14 million for contraceptive supply procurement was not even used.

The complete lack of educational and awareness campaigns informing the public, especially the large numbers of youth, of the dangers of contracting HIV/AIDS is surely leading to disastrous consequences. In one survey men aged between 15 and 45 were asked what they thought would protect them from HIV. The three most popular answers: taking antibiotics, keeping fit and healthy, and saying a prayer. Which makes Wilkinson wonder: While other countries have been initiating HIV/AIDS education programs and promoting condom use, the Philippines has been going the other way, leading to a sharp decline in the use of condoms. Combine this with the fact that tens of thousands of overseas workers, many of whom admittedly engage in risky sexual behavior, return to the country every year. All of this would make the Philippines ripe for an epidemic, wouldn't it? Just how is it that the numbers of HIV infected in the Philippines are some of the lowest in the world?

One clue comes in the fact that few high-risk people ever get tested for HIV/AIDS. Sex workers in the honky-tonk town of Angeles City are tested weekly for sexually transmitted diseases, but they are not required to take an AIDS test. In fact it's illegal in the Philippines to force somebody to take an AIDS test. Naturally nobody, especially a bar girl, is going to volunteer to have an AIDS test done, as a positive result could be the end of her livelihood. Anyway, the sex trade is technically illegal in the Philippines so there's no way for the government to control it.

Another factor in the underreporting of HIV/AIDS cases comes from the many doctors in the provinces who, through sheer ignorance, may treat a particular disease without knowing the patient has HIV. Victims are said not to die of AIDS. Instead they die of tuberculosis, meningitis, pneumonia, etc. Another factor is the tremendous social stigma that comes with being HIV-positive in the Philippines. Thus some doctors, often at the pleading of their patients, do not report an HIV-positive test to the Department of Health.

Thus, the DOH figures are clearly way off base. Conservative estimates are that 10 times the stated number have HIV. Flavier, who is now a senator, believes it's 100 times the official figure. So, by various estimates, between 15,000 and 150,000 Filipinos are out there with the AIDS virus. And statistics indicate that a majority of them are sexually active and will not wear condoms.

Could HIV/AIDS in the Philippines really be "low and slow", especially seeing as all the ingredients for an epidemic are so glaringly obvious? Other countries also believed they were "low and slow" before seeing a sharp rise in infections, such as Vietnam and Indonesia. But, in fact, the virus may have already spread beyond "low and slow" in the Philippines. Wilkinson points out that STIs have been continually rising in the country for several years, and people with STIs are more likely to contract HIV than those without. Tuberculosis has been on the rise as well, which in the Philippines which might mean that AIDS is on the rise too.

Wilkinson claims that through its complacency and outright denial of the problem, the Philippine government, along with the Church, is dooming tens of thousands of Filipinos, if not more, to die horrible deaths because of AIDS. Unless, of course, there is a veritable miracle happening throughout the country. But while the Philippines might be a country where many miracles do occur, continuing to believe in this one is obviously going to prove terribly costly.

"There is no room for complacency," said Dr Nafis Sadik, the UN secretary general's special envoy for HIV/AIDS in Asia, who is quoted in Wilkinson's book. There is a "huge explosion potential" for HIV/AIDS in the Philippines because "all known routes of transmission have been observed here".

(AIDS Failure Philippines? is published by Book of Dreams, Verlag, Germany. For more information please visit

Ted Lerner is the author of the book Hey, Joe - A Slice of the City, an American in Manila, as well as an upcoming book of Asian travel stories, The Traveler and the Gate Checkers. E-mail or visit

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Apr 3, 2003

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